title: Factors associated with early cancer-related death after curative hepatectomy for solitary small hepatocellular carcinoma without macroscopic vascular invasion.
abstract: BACKGROUND
  Unexpected early cancer-related death (ECRD) within 2 years due to recurrence after curative hepatectomy for solitary small (<5 cm) hepatocellular carcinoma without macroscopic vascular invasion (SSHCC) is occasionally observed.
  
  
  METHODS
  A total of 415 patients were enrolled (19 patients with ECRD and 396 patients with non-ECRD) to elucidate the risk factors of ECRD after curative hepatectomy for SSHCC. They were initially compared by limiting variables to preoperative factors to reveal predictors that could enable the modification of primary treatment. Subsequently, the same analysis was performed with all variables, including perioperative and histological factors.
  
  
  RESULTS
  In the preoperative factors, tumor size > 3 cm and elevation of tumor marker level were independent predictors of ECRD. In the analysis with all variables, excessive intraoperative blood loss, poor differentiation, and microscopic vascular invasion were predictors of ECRD. In the recurrence patterns, 79% of ECRD presented as advanced (four or more lesions) or extra-hepatic recurrence, whereas these accounted for 18% in the non-ECRD.
  
  
  CONCLUSIONS
  Excessive blood loss during the operation and histopathological findings of microscopic vascular invasion and poor differentiation are predictive factors of cancer-related death within 2 years of a hepatectomy for SSHCC.
authors.affiliation: Department of Digestive Surgery, Hepato Pancreato Biliary Surgery Unit, Toranomon Hospital, Tokyo, Japan. sasaki-kz@toranomon.gr.jp.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Sasaki
authors.forename: Masamichi
authors.initials: M
authors.lastname: Matsuda
authors.forename: Yu
authors.initials: Y
authors.lastname: Ohkura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Inoue
authors.forename: Masaji
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Ikeda
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kumada
authors.forename: Goro
authors.initials: G
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005544:Forecasting; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012307:Risk Factors
keywords: Early cancer-related death; Hepatectomy; Hepatocellular carcinoma